CLINICAL AND COST OUTCOMES OF MULTIFACTORIAL, CARDIOVASCULAR RISK MANAGEMENT INTERVENTIONS IN WORKSITES - A COMPREHENSIVE REVIEW AND ANALYSIS

This paper critical review of the clinical and cost outcome evaluation management programs in worksites. A comprehensive international liter ature search conducted under the a identified 17 articles based on 12 studies that examined the clinical outcomes of multifactorial, compreh ensive programs. These articles were identified through MEDLINE, manua l searches of recent journals, and through direct inquiries to worksit e health promotion researchers. All studies were conducted between 197 8 and 1995, methodologically rigorous evaluation. Of the 12 research s tudies, only 8 utilized the worksite as both the unit assignment and a s the unit of analysis. None of the studies analyzed adequately for co st effectiveness. Given this limitation, this review demonstrated cost outcomes. Worksite-based, multifactorial cardiovascular intervention programs reviewed for this article varied widely in the comprehensiven ess, both the interventions and evaluations. Results from randomized t rials suggest that providing opportunities for individualized, cardiov ascular risk reduction counseling for high-risk employees within the c ontext programming may be the critical component of an intervention. D espite the many limitations of the current methodologies of the 12 stu dies, the majority of the research to date indicates the following (I) favorable clinical and cost outcomes; (2) that more recent and more ri gorously designed research tends to support rather than less rigorousl y designed studies; and (3) that rather than interpreting the methodol ogical flaws and diversity as inherently negative one may consider it as indicative of a robust phenomena evident in many types of worksites , with diverse employees, differing interventions, and varying degrees of methodological sophistication. Results of these studies reviewed p rovide both cautions optimism about the effectiveness of these worksit e programs and insights regarding the essential components and charact eristics of successful programs.